Common Oral Conditions: A Clinical Overview for Dental Professionals | ICPA

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A recent review published in JAMA (March 2024) by Stoopler et al. offers an evidence-based synthesis of three of the most prevalent oral conditions:
1. Xerostomia (dry mouth)
2. Oral candidiasis
3. Recurrent aphthous stomatitis (RAS).
These conditions are frequently encountered in dental practice and can significantly impact patient comfort and quality of life.

Xerostomia (Dry Mouth)

Prevalence and Etiology

Xerostomia affects approximately 23% of the global population. Key risk factors include polypharmacy (use of more than three oral medications daily; OR: 2.9), head and neck radiation therapy, and autoimmune disorders such as Sjögren’s syndrome.

Clinical Manifestations

Patients may report difficulty in swallowing and speaking, persistent thirst, halitosis, and a burning sensation. Xerostomia is associated with an increased risk of dental caries, dysgeusia, masticatory and speech impairments, and oropharyngeal dysphagia.

Management Strategies

First-line treatments include mechanical salivary stimulants, oral moisturizers, and systemic sialagogues. Addressing underlying causes, such as medication review and management of systemic conditions, is crucial.

Oral Candidiasis

Epidemiology and Risk Factors

Oral candidiasis is predominantly caused by Candida albicans, accounting for 76.8% of cases. Higher prevalence is noted among immunosuppressed individuals, including those with HIV (35%) and patients with salivary gland hypofunction (OR: 3.02). Additional risk factors encompass antibiotic usage and oral mucosal disorders like lichen planus.

Clinical Presentation

Symptoms include oral burning sensations, dysgeusia, and the presence of white plaques or erythematous lesions on the oral mucosa.

Therapeutic Approaches

Management involves the use of topical antifungal agents, such as nystatin or clotrimazole, and systemic antifungals in refractory cases. Elimination of predisposing factors is essential to prevent recurrence.

Recurrent Aphthous Stomatitis (RAS)

Pathogenesis and Associated Factors

RAS is characterized by recurrent, painful oral ulcers with a gray-white fibrinous base and erythematous halo.
1. Genetic predispositions, including polymorphisms in IL-1β (+3954C/T and -511C/T), have been linked to increased susceptibility.
2. Nutritional deficiencies, notably in vitamin B12 (OR: 3.75), folic acid (OR: 7.55), and ferritin (OR: 2.62), are also associated.
3. Systemic conditions like celiac disease show a higher incidence of RAS (25% vs. 11%; OR: 3.79).

Management Protocols

Topical corticosteroids remain the cornerstone of RAS treatment. In severe or unresponsive cases, systemic therapies may be warranted. Addressing nutritional deficiencies and managing underlying systemic diseases are integral to comprehensive care.

Conclusion

Xerostomia, oral candidiasis, and RAS are prevalent conditions with significant implications for oral health. Early recognition and a multifaceted management approach, including symptomatic relief and addressing underlying etiologies, are vital for optimal patient outcomes.

For a comprehensive review, refer to the full article: https://jamanetwork.com/journals/jama/article-abstract/2816624